Transcript Selection considerations

Taping
Principles of Taping
“The application of tape is an art, and, in the
hands of the inexperienced it may be very difficult.
Practice is essential to good taping. Neatness is the
trademark of a good taper. Be neat, and the respect
of the athlete will be earned….The beginner should
start slowly; the application of tape should be very
deliberate and neat. After much practice and
speed, efficiency will be the result.”
- Stephen Rice, MD
Selection considerations
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Diagnosis of injury
Goals of taping
Resource available
Sport & position
Athletes acceptance
Research findings
Personal preference
Diagnosis of injury
• Location
• Nature
• Severity
Selection considerations
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Diagnosis of injury
Goals of taping
Resource available
Sport & position
Athletes acceptance
Research findings
Personal preference
Goals of taping
• Prophylactic
• Rehabilitative
• Functional
Selection considerations
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Diagnosis of injury
Goals of taping
Resource available
Sport & position
Athletes acceptance
Research findings
Personal preference
Resource available
• Human resource
• Financial resource
Selection considerations
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Diagnosis of injury
Goals of taping
Resource available
Sport & position
Athletes acceptance
Research findings
Personal preference
Sport and position
• A taping that is effective for an athlete in
one sport may not be suitable for another
athlete
• A taping that is effective for an athlete in
one sport may not be suitable in another
sport
• Requirements, Equipment, Environment &
Rules
Selection considerations
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Diagnosis of injury
Goals of taping
Resource available
Sport & position
Athletes acceptance
Research findings
Personal preference
Athlete’s acceptance
• If the athlete feels that taping is
uncomfortable or decreases
performance the attempt to support
will failed
Selection considerations
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Diagnosis of injury
Goals of taping
Resource available
Sport & position
Athletes acceptance
Research findings
Personal preference
Research findings
• With respect to new techniques or products,
it is probably best to keep an open mind but
to be critical
Selection considerations
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Diagnosis of injury
Goals of taping
Resource available
Sport & position
Athletes acceptance
Research findings
Personal preference
Personal preference
• After gaining clinical experience with
various taping techniques, one usually
begins to have with relying on experience
when the athlete is looking for expert
answers, as long as each case is viewed
individually.
TAPING MECHANISMS:
• MECHANICAL
• PROPRIOCEPTIVE
(DIRECT REFLEX STIMULATION– LEARING
PROCESS )
Re-establishing Neuromuscular Control,
Proprioception, Kinesthesia and Joint
Position Sense
• Following injury, body forgets how to integrate
information coming in from multiple biological sources
• Neuromuscular control is mind’s attempt to teach the
body conscious control of a specific movement
• Re-establishing neuromuscular control requires
repetition of same movement, step by step until it
becomes automatic (progression from simple to
difficult task
• Closed kinetic chain (CKC) exercises are essential for
re-establishing control but can be difficult
• Must regain established sensory pattern
• CNS constantly compares intent and production of
specific movement w/ stored information, constantly
modifying until discrepancy in movement is corrected
• Four key elements
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Proprioception and kinesthetic awareness
Dynamic stability
Preparatory and reactive muscle characteristics
Conscious and unconscious functional and motor patterns
• Must relearn normal functional movement and timing
after injury - may require several months
• Critical throughout rehab - most critical early in
process to avoid reinjury
• Reestablishing proprioception and kinesthesia
should be of primary concern
– Proprioception is joint position sense (determine
position of joint in space)
– Kinesthesia is the ability to detect movement
• Kinesthesia and proprioception are mediated
by mechanoreceptors in muscle and joints,
cutaneous, visual, and vestibular input
• Neuromuscular control relies on CNS to
integrate all areas to produce coordinated
movement
• Joint Mechanoreceptors
– Found in ligaments, capsules, menisci, labra, and
fat pads
• Ruffini’s endings
• Pacinian corpuscles
• Free nerve endings
– Sensitive to changes in shape of structure and
rate/direction of movement
– Most active at end of ranges of motion
• Muscle Mechanoreceptors
– Muscle spindles - sensitive to changes in length of
muscle
– Golgi tendon organs - sensitive to changes in
tissue tension
Regaining Balance
• Involves complex integration of muscular forces,
neurological sensory information from
mechanoreceptors and biomechanical information
• Entails positioning center of gravity (CoG) w/in
the base of support
• If CoG extends beyond this base, the limits of
stability have been exceeded and a corrective step
or stumble will be necessary to prevent
• Even when “motionless” body is constantly
undergoing constant postural sway w/ reflexive
muscle contractions which correct and maintain
dynamic equilibrium in an upright posture
• When balanced is challenged the response is reflexive
and automatic
• The primary mechanism for controlling balance
occurs in the joints of the lower extremity
• The ability to balance and maintain it is critical for
athletes
• If an athlete lacks balance or postural stability
following injury, they may also lack proprioceptive
and kinesthetic information or muscular strength
which may limit their ability to generate an adequate
response to disequilibrium
• A rehabilitation plan must incorporate functional
activities that incorporate balance and proprioceptive
training
Principle of taping
• Tape selection
• Skin care
• Application
Tape selection
• Size
• Type
• Quality
Principle of taping
• Tape selection
• Skin care
• Application
Skin care
• Skin surface should be clean of oil,
perspiration and dirt
• Hair should be removed to prevent skin
irritation with tape removal
• Tape adherent is optional
• Foam and skin lubricant should be used to
minimize blisters
Principle of taping
• Tape selection
• Skin care
• Application
Rules for Tape Application
• Tape in the position in which joint must be
stabilized
• Overlap the tape by half
• Avoid continuous taping
• Keep tape roll in hand whenever possible
• Smooth and mold tape as it is laid down on
skin
• Allow tape to follow contours of the skin
Rules for Tape Application (cont.)
• Start taping with an anchor piece and finish
by applying a locking strip
• Where maximum support is desired, tape
directly to the skin
• Do not apply tape if skin is hot or cold from
treatments
Type of tape
• Elastic
• Non- Elastic
Uses of elastic taping
• To compress & support soft tissue
• To provide anchors around muscle thus
allowing for expansion
• To hold protective pads in place
Uses of non-elastic taping
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To support inert structures
To limit joint movement
To protect against re-injury
To secure ends of elastic tape
To reinforce elastic tape
To enhance proprioception
Materials
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Bandaging materials
Padding
Underlying bandages
Fixation bandages
Elastic bandages
Adhesive bandages
Additional materials
Classification
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According to time of application
According to type of bandage
According to bandaging technique
According to bandage materials
Time of application
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First bandage
Second bandage
Later bandage
Prophylactic bandage
Type of bandage
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Open wound
Compression bandage
Immobilizing bandage
Supportive bandage
Bandaging technique
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Circular bandage (dolabra asc. or desc.)
Testudo rev. or inv.
Spica asc. or desc.
Head bandage (mitra rev. or inv.)
Bandaging material
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Elastic bandage
Adhesive bandage
cloth tape
Self-sticking bandage
Materials
• Gauze- sterile pads for wounds, hold dressings in
place (roller bandage) or padding for prevention of
blisters
• Cotton cloth- ankle wraps, triangular and cravat
bandages
• Elastic bandages- extensible and very useful with
sports; active bandages allowing for movement;
can provide support and compression for wound
healing
• Cohesive elastic bandage- exerts constant even
pressure; 2 layer bandage that is self adhering;
Elastic Bandages
• Gauze, cotton cloth, elastic wrapping
• Length and width vary and are used
according to body part and size
• Sizes ranges 2, 3, 4, 6 inch width and 6 or
10 yard lengths
• Should be stored rolled
• Bandage selected should be free from
wrinkles, seams and imperfections that
could cause irritation
Elastic Bandage Application
• Hold bandage in preferred hand with loose
end extending from bottom of roll
• Back surface of loose end should lay on
skin surface
• Pressure and tension should be standardized
• Anchor are created by overlapping wrap
– Start anchor at smallest circumference of limb
• Body part should be wrapped in position of
maximum contraction
• More turns with moderate tension vs. fewer
turns with maximum tension
• Each turn should overlap by half to prevent
separation
• Circulation should be monitored when
limbs are wrapped
Elastic bandages can be used to provide
support for a variety scenarios:
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Ankle and foot spica
Spiral bandage (spica)
Groin support
Shoulder spica
Elbow figure-eight
Gauze hand and wrist
figure-eight
• Cloth ankle wrap
Triangle and Cravat Bandages
• Cotton cloth that can be substituted if roller
bandages not available
• First aid device, due to ease and speed of
application
• Primarily used for arm slings
– Cervical arm sling
– Shoulder arm sling
– Sling and swathe
Cervical Arm Sling
• Designed to support forearm, wrist and hand
injuries
• Bandage placed around neck and under bent
arm to be supported
Shoulder Arm Sling
• Forearm support when
a shoulder girdle
injury exists
• Also used when
cervical sling is
irritating
Sling and Swathe
• Combination utilized
to stabilize arm
• Used in instances of
shoulder dislocations
and fractures
Non-elastic White Tape
• Great adaptability due to:
– Uniform adhesive mass
– Adhering qualities
– Lightness
– Relative strength
• Help to hold dressings and provide support and protection to
injured areas
• Come in varied sizes (1”, 1 1/2” , 2”)
• When purchasing the following should be considered:
• Tape Grade
– Graded according to longitudinal and vertical
fibers per inch
– More costly (heavier) contains 85 horizontal
and 65 vertical fibers
• Adhesive Mass
– Should adhere regularly and maintain adhesion
with perspiration
– Contain few skin irritants
– Be easily removable without leaving adhesive
residue and removing superficial skin
• Winding Tension
– Critically important
– If applied for protection tension must be even
Elastic Adhesive Tape
• Used in combination with non-elastic tape
• Good for small, angular parts due to
elasticity.
• Comes in a variety of
widths (1”, 2”, 3”, 4”)
Preparation for Taping
• Skin surface should be clean of oil,
perspiration and dirt
• Hair should be removed to prevent skin
irritation with tape removal
• Tape adherent is optional
• Foam and skin lubricant should be used to
minimize blisters
• Tape directly to skin
• Prewrap (roll of thin foam) can be used to
protect skin in cases where tape is used
daily
• Prewrap should only be applied one layer
thick when taping and should be anchored
proximally and distally
• Proper taping technique
– Tape width used dependent on area
– Acute angles = narrower tape
• Tearing tape
– Various techniques can be used but should
always allow athlete to hold on to roll of tape
– Do not bend, twist or wrinkle tape
– Tearing should result in straight edge with no
loose strands
– Some tapes may require cutting agents
Taping Guidelines
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Place joint in position to be stabilized
Overlap tape ½ width
Avoid continuous taping
Keep roll in hands at all times
Smooth and mold time with free hand
Do not force tape
Start with an anchor and end with a lock strip
Do not tape after a cold / hot modality treatment
Rules for Tape Application
• Tape in the position in which joint must be
stabilized
• Overlap the tape by half
• Avoid continuous taping
• Keep tape roll in hand whenever possible
• Smooth and mold tape as it is laid down on
skin
• Allow tape to follow contours of the skin
Rules for Tape Application (cont.)
• Start taping with an anchor piece and finish
by applying a locking strip
• Where maximum support is desired, tape
directly to the skin
• Do not apply tape if skin is hot or cold from
treatments
Taping, Bandaging and Splinting
Techniques
• Wrist / Hand / Finger
– Wrist hyperextension / flexion taping
• Fan or spica
– Finger buddy taping
– Thumb hyperextension / abduction taping
• Fan or spica
• Elbow
– Hyperextension taping
• Fan or spica
Taping, Bandaging and Splinting
Techniques
• Lower Leg
– Achilles
• Fan or spica
• Ankle
– Closed gibney basketweave
– Open gibney basketweave
• Foot / Toes
– Arch
• “X”
• Teardrop
• Spread / Fan
– Turf toe
• Fan
Additional Taping Information
• Removing adhesive tape
– Removable by hand
• Always pull tape in direct line with body (one hand
pulls tape while other hand presses skin in opposite
direction
– Aid of tape scissors and cutters may be required
• Be sure not to aggravate injured area with cutting
device
– Also removable with chemical solvents
Taping Supplies
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Razor (hair removal)
Soap (skin cleaning)
Alcohol (oil removal)
Adhesive spray
Prewrap material
Heel and lace pads
White non-elastic tape
• Elastic adhesive tape
• Felt and foam padding
material
• Tape scissors
• Tape cutters
• Elastic bandages
Common Foot Taping
Procedures
Arch
Technique 1
(to strengthen
weakened arches)
Arch Technique
2
(for longitudinal
arch)
Arch
Technique 3
(X teardrop arch
and forefoot
support)
Arch Technique 4
(fan arch support)
LowDye Technique
(Management of fallen arch, pronation, arch
strains and plantar fascitis)
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Sprained Toes
Bunions
Turf Toe
(prevents excessive hyperextension of
metatarsophalangeal joint)
Hammer or Clawed Toes
Fractured
Toes
Common Ankle Taping
Procedures
Routine Non-Injury Taping
• Routine Non-injury taping
• Closed Basket Weave
– Used for newly sprained or chronically weak
ankles
• Open Basket Weave
– Allows more dorsiflexion and plantar flexion,
provides medial and lateral stability and room
for swelling
– Used in acute sprain situations in conjunction
with elastic bandage and cold application
Closed Basket weave (Gibney) Technique
Open Basket
Weave
Continuous-Stretch Tape
Technique
Common Leg & Knee Taping
Procedures
Achilles Tendon
(prevent Achilles over-stretching)
Collateral
Ligament
Rotary Taping for Knee
Instability
Knee
Hyperextension
(Prevent knee
hyperextension,
provide support to
injured hamstring or
slackened cruciate
ligament)
Patellofemoral Taping
(McConnell technique)
• Helps to manage glide, tilt, rotation and
anteroposterior orientation of patella
• Accomplished by passively taping patella
into biomechanically correct position
• Also provides prolonged stretch to softtissue structures associated with dysfunction
Patellofemoral
Taping
(McConnell
technique)
Patellofemoral
Taping
(McConnell
technique)
Patellofemoral
Taping
(McConnell
technique)
Patellofemoral
Taping
(McConnell
technique)
Patellofemoral
Taping
(McConnell
technique)
Common Upper Extremity
Taping Procedures
Elbow
Restriction
(Prevents elbow
hyperextension)
Wrist Technique 1
(Mild wrist sprains and strains)
Wrist Technique 2
(Protects and stabilizes badly injured wrist)
Bruised Hand
Sprained
Thumb
(Provide
support to
musculature
and joint)
Finger and Thumb Checkreins